A patient abusing cocaine presents to the ER with chest pain. ECG shows ST elevation in leads II, III, aVF. Which medication used commonly for myocardial infarction is RELATIVELY CONTRAINDICATED in cocaine-induced acute coronary syndrome?
- A Non-selective beta-blocker (propranolol) ✓
- B Aspirin
- C Sublingual nitroglycerine
- D Benzodiazepines
Correct answer: A. Non-selective beta-blocker (propranolol)
Explanation
Non-selective beta-blockers (propranolol) are relatively contraindicated in cocaine-induced coronary syndrome because blocking beta-2 vasodilatory receptors while cocaine's alpha-1 vasoconstriction remains unopposed (due to its norepinephrine release) paradoxically worsens coronary vasospasm and may increase blood pressure. Labetalol (mixed alpha+beta blocker) is less contraindicated. Benzodiazepines are first-line (reduce sympathetic drive), sublingual nitroglycerine relieves vasospasm, and aspirin is appropriate.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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